Provider Demographics
NPI:1881958650
Name:PEKKER, TATIANA (MFT)
Entity type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:
Last Name:PEKKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 AMADOR AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-3431
Mailing Address - Country:US
Mailing Address - Phone:650-279-2768
Mailing Address - Fax:
Practice Address - Street 1:327 N SAN MATEO DR
Practice Address - Street 2:URSA4MINOR@YAHOO.COM
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2543
Practice Address - Country:US
Practice Address - Phone:650-279-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist